Name:   

          Date of Birth (MM/DD/YYYY):

          Sex (M/F)       

Street:         

City:  

State:  

          Zip:     

Home Phone:    Bus/Cell Phone:    Email:

Drivers License Number:     Issuing State:

          Drivers License Expiration Date (MM/DD/YYYY) :

 

          Season you would like to coach in (example: 2011 Spring Season):

League requesting to coach in:

          Role you would like to be considered for: Manager     Assistant Coach

Name of person you will be coaching with, if applicable:  

Sponsor Name, if applicable:

          Name(s) of child or children that you want to coach or manage:

Have you ever been convicted of or pleaded guilty to any crime(s): Yes      No

          If yes, you will be contacted if further details are needed.

Have you ever been refused participation in any other youth programs? Yes      No

          If yes, please explain:

         As a condition of volunteering, I give my permission for the Howell Area Junior Baseball Association to conduct a

         background check on me, which may include a review of sex offender registries and criminal history records.  I

         understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on

         my background.  I hereby release and agree to hold harmless from liability Howell Area Junior Baseball Association,

         the officers, employees, and volunteers thereof, or any other person or organization that may provide such information.

         I also understand that, regardless of previous appointments, Howell Junior Baseball Association Incorporated is not

         obligated to appoint me to a volunteer position.  If appointed, I understand that, prior to the expiration of my term;

         I am subject to suspension by the President and removal by the Board of Directors for violation of Howell Area Junior

         Baseball Association.

 Submission of this form indicates that  I agree to the terms stated above: